A story of love, sex and dreams
CHAPTER 4 Chapter 4: Results
4.1 Randomisation and allocation of schools and learners to the study Total Number of Schools
4.3.2 Knowledge
Knowledge about the cause, spread, prevention of, and protection against sexually transmitted infections
Table 5 describes questions related to the causes, spread, treatment and methods of protection against sexually transmitted infections by group.
Computed results on the spread of sexually transmitted infections indicated that 79.1
% of respondents answered 3 - 5 questions correctly and 86.7% were in agreement that sexually transmitted infections are spread by unprotected sex.
Over 75 % oflearners were in agreement on the questions related to the sexual causes of sexually transmitted infections, namely unprotected sex and having many sexual partners. Significantly more males than female respondents believed that girls were the cause of sexually transmitted infections (p< 0.05).
Learners' knowledge about the use of a condom to protect oneself against sexually transmitted infections was favourably reflected by the response rate of 86.2 %. However, the computed results on protection revealed that only 40.6 % oflearners gave the expected answer for 3 out of 6 statements. This is lower than the computed results for knowledge about causes and spread of sexually transmitted infections but compares with the computed results of knowledge about treatment for which 42.5 % of learners gave the expected response for 3 out of 6 statements.
Table 5: Learners Knowledge about the Cause, Spread, Treatment of, and the Protection from, Sexually T ransmItte . dI~' n ectlOns-P ercentage
CONTROL INTERVENTION
Knowledge Variable %In % Not In 0/0 % In % Not In %
Agreement A!!reement Unsure A!!reement A!!reement Unsure Sexually transmitted
infections Caused by
Condoms 26.4 60.2 13.5 23.3 64.7 12.0
Contraceptives 15.3 60.0 24.6 13.1 57.8 29.1
Girls 44.1 33.8 * 22.1 40.6 27.1* 32.3
Witchcraft 15.8 53.9 30.3 17.2 51.3 31.5
Dirty blood 34.2 32.1 33.7 37.9 35.9 35.9
Unprotected sex 76.9 16.0 7.1 74.6 15.9 9.4
Having many sexual 81.4 11.9 6.7 78.2 14.4 7.4
partners
Sexually transmitted infections are Spread by:
Food and utensils 6.5 78.7 14.8 7.2 75.4 17.4
Hugging 2.6 89.9 7.5 3.8 87.5 8.7
Unprotected sex 88.4 7.0 4.5 84.9 10.5 4.6
Kissing 7.5 79.7 12.8 8.6 75.9 15.5
Toilet seats 11.7 67.9 20.4 14.4 64.0 21.6
A person protects oneself from getting an STI by
Having one faithful 75.4 11.4 13.3 74.3 13.8 11.8
partner
Kissing and cuddling only 48.4 * 33.3 18.3 41.9 * 32.3 25.8
Not having sex 63.0 26.6 10.4 60.4 24.5 15.1
Taking family planning 30.5 43.7 25.8 30.0 40.6 29.4
pills
Using a condom 85.4 7.4 7.1 87.0 7.3 5.7
If you were on treatment, would you
Stop the treatment when 12.6 68.7 18.5 14.2 68.9 16.9
you felt better
Share treatment with a 41.2 43.8 14.8 36.1 50.0 13.9
friend, if he / she needs it
Have sex without a 10.1 82.2 * 7.5 17.7 74.8 * 7.5
condom
If you had an STI, would you go for treatment
As soon as you have 70.8 * 6.9 22.3 61.3 * 10.5 28.2
symptoms
No symptoms, but partner 49.5 17.6 is infected
32.9 42.3 19.5 38.2
n (1168) Bold DeSirable Response
* -
Slgmficant Difference (p < 0.05)48
The response to an open ended question about protection indicated that 81 % of respondents were able to suggest a way to protect themselves against sexually transmitted infections. This included the use of condoms, delaying sex and a combination of using condoms and being faithful to their partner. Almost eighty three percent of male learners and fifty three percent of female learners reported that they knew how to use a condom.
However in an open question that personalized whether a participant would know ifhe / she had a sexually transmitted infection, only 19 % knew the symptoms of sexually transmitted infections, 29 % were unsure and 24 % would consult a doctor for an
examination or blood tests to be done. It must be noted that 28 % of the sample did not respond to this question.
Knowledge sources: Learners' sources of information about sexually transmitted infections
Of the respondents significantly more in the control group (83.7%) than the intervention group (75.8%) had heard people talk about sexually transmitted infections, while 70.3% in the control group and 57.4% in the intervention group reported that they knew what a sexually transmitted infection was, (p<O.OI). Significantly more learners in the control group than the intervention group were able to name a sexually transmitted infection (p = 0.01), (AIDS / HIV was listed by half the respondents and about thirty four percent listed 'idrop', a colloquial word for a sexually transmitted infection). The
remainder detailed other individual conditions such as gonorrhoea, warts or a combination of conditions for example AIDS or idrop with thrush or herpes.
As depicted in Table 6, the most common reported source of information about sexually transmitted infections for both male and female learners was the media including
newspapers, magazines and television. Friends and clinics played an important role as sources of information to males and females respectively. Family was reported as the least accessed source of information. In terms of the group differences significantly more learners in the control group than the intervention group reported hearing about sexually transmitted infections from friends, teachers and family (p < 0.01).
T bl 6 S a e
. .
econ ary d S C 00 h IL earners , S ources 0 fl norma Ion ~ fHeard about sexually MALE FEMALE PVALUE
transmitted infections from:
Media 83,6% 84,6% 0.07
Friends 72,0% 64,2% 0.02
Clinic 53,0% 68,5% <0.01
Teachers 48,3% 50,9% 0.45
Family 33,6% 32,9% 0.42
n
=
1168Knowledge sources: Learners' communication about sexual issues with significant others Tables 7a -7c indicate that both males and females in the control and intervention groups communicated mainly with friends about sensitive issues. However there was a significant gender difference within the groups with regard to the communication topic.
Significantly more male than female respondents in the intervention group talked about condom use and sexually transmitted infections than those in the control group. There was a significant gender difference within both groups with more males than females reporting talking about having sex to their partners.
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T bl 7 S a e a: econ d ary c S h IL 00 earners 'C ommUDlca IOn WI . . t' 'th Parents
CONTROL INTERVENTION
M F P Value M F P Value
HIV/AIDS 41.6 53.3 < 0.01 53.1 52.3 0.67
Condom use 37.9 41.2 0.36 48.1 33.9 < 0.01
Sexually 32.9 39.6 0.07 35.0 32.6 0.73
transmitted infections
Having sex 29.2 28.9 0.69 39.7 25.2 <0.01
n = 1168 Bold = significant difference between gender wlthm group M = Male F = Female
T bl 7b S a e
. .
econ ary c d S h IL 00 earners'C
ommuDlca Ion WI . t' 'thF' d rIen sCONTROL INTERVENTION
M F P Value M F P Value
HIV/AIDS 70.1 81.3 < 0.01 76.2 75.5 0.54
Condom use 81.7 79.2 0.54 85.2 71.2 <0.01
Sexually 61.1 67.0 0.37 65.1 54.6 0.04
transmitted infections
Having sex 82.9 66.4 < 0.01 81.9 60.6 <0.01 Not having sex 49.8 71.2 <0.01 48.9 69.6 <0.01
n -1168 Bold - slgmficant difference between gender wlthm group M = Male F = Female
Table 7c: Secondary School Learners' Communication with Partner
CONTROL INTERVENTION
M F P Value M
HIV/AIDS 55.7 65.7 0.03 63.2
Condom use 63.9 61.0 0.39 74.2
Sexually 43.4 54.8 0.03 56.2
transmitted infections
Having sex 64.2 51.7 <0.01 77.8 Not having sex 39.1 59.7 <0.01 44.1
n 1168 M=Male
Bold slgmficant difference between gender wlthm group F= Female
F P Value
60.4 0.22
64.7 0.01
48.9 0.02
50.9 < 0.01 61.1 < 0.01
4.3.3 Attitudes
Attitude to Condom Use
Attitude to condom use was assessed by the responses to eight specific statements.
T bl a e 8 : S econ d ary c S h IL 00 earners 'Atft d t C d I u e 0 on om se U
CONTROL INTERVENTION
Statement %In % Not In % Unsure %In % Not In % Unsure Agreement Agreement Agreement Agreement
M F M F M F M F M F M F
Condoms take 29.0 17.0 39.0 41.7 32.1 41.3 31.2 18.8* 42.2 39.0 26.6 42.2
the fun out of * * * * * * *
sex
Condoms are 17.4 12.5 61.3 54.5 21.3 33.0 15.5 14.8 61.8 53.9 22.7 31.3
embarrassing * *
to use
Condoms can 5.2 10.4 72.3 55.6 22.5 34.0 9.4 13.0 24.4 35.9 66.2 51.1
harm your * * * * * * * *
body
Condoms are 80.3 88.9 10.2 4.5 9.5 6.6 83.5 87.5 11.4 4.7 5.1 * 7.8
important to * * * * * * *
use every time you have sex
Using a 25.9 23.8 56.3 58.3 17.7 17.9 31.9 26.5 59.2 55.2 8.8 18.3
condom shows * *
partner that you do not trust him / her
Condoms 74.7 75.5 6.1 6.2 19.1 18.3 81.4 72.8* 6.4 7.5 12.3 19.7
work well to * * *
prevent sexually transmitted infections
Condoms also 84.9 82.4 4.8 6.6 10.3 11.0 89.4 83.8 5.5 6.2 5.1 10.0 prevent
pregnancy
Using a 88.8 88.7 3.4 2.7 7.8 8.6 92.3 87.5 4.3 4.4 3.4 8.1 condom shows
you care about your and your partners health
Cn 1168) BOLD Favourable or correct response * - p < 0.05 between gender within groups M = Male F = Female
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Although significantly more males in both the control and intervention groups believed that condoms take the fun out of sex, significantly more males in both groups also believed that condoms are not embarrassing to use and do not harm the body, respectively (p < 0.05). Both males and females (68.4%) responded favourably to more than four ofthe eight statements.
4.3.4 Learners' beliefs and perceptions about sexually transmitted infections
In response to five questions about learners' beliefs and perceptions about sexually
transmitted infections both males and females reported that sexually transmitted infections were a serious health problem for adolescents. More than half of the respondents (of both sexes and in the control and intervention groups) feared that they were at risk of getting a STI. This response decreased (for both males and females), when considering their vulnerability over the next two years with significantly more intervention versus control respondents reported knowing a friend with a sexually transmitted infection (P=O.Ol).
100 90 80
Cl) 70
III C
0 60
Cl. III
l.
CD 50
>
:;::I
·iii 0 40
Il.
~ 0 30 20 10 0
sn serious Personally Get an sn in the Had an sn Know a friend with sn
health problem scared of getting next 2 years
sn
Perception Variables (n=1168)
m Control IIlntel'.ention
Figure 2: Perception of STI Problem among Secondary School Learners
4.3.5 Sexual practices and condom use
A question about the right age to start having sex indicated that 47.8 % of the learners were in agreement with the age category 15 - 19 years old. There was a
significant gender difference within the control group and between female respondents in the control and intervention groups (p < 0.05).
Of the sample 43.3 % reported having been sexually active in the past six months, with significantly more being male learners 53.2 % compared to female learners 34.3%
(p<0.05). This statistically significant gender difference was found in both the control and intervention groups (p<0.05).
Of the learners reporting positively to having had sex in the past six months 77 % were between the ages of 15 to 19 years old, and 35.7% reported not having used a condom at all. Of the learners reporting using condoms 35% indicated using a condom
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every time and 40.1 % sometimes. For 76.6 % of the learners the clinic was the main source for condom acquisition. Of the male learners who did not use condoms 41.9%
reported that it was due to personal preference. However, only 22.1 % of female learners reported that their partners refused to use condoms. There was no significant difference between control and intervention groups in response to this question.
4.3.6 Learners' impressions of Laduma
The learners in the intervention group were asked a series of questions about Laduma to assess their appreciation of it as educational print media. The majority (89% - 95%) of the learners reported that they thought Laduma was interesting, easy to
understand and educational. Even though 90% were Zulu speaking, 75% reported a preference for reading it in English and the remainder would have preferred it in isiZulu.
They disagreed with less positive statements, for example 67% disagreed that their friends will laugh at them if they used condoms, and agreed with positive statements such as condoms protect against sexually transmitted infections (77%). A substantial
percentage of unsure responses to statements, for example, condoms are not a part of your culture (25.2%), a condom may slip and get stuck inside a girl (38.8%) and my
girlfriendlboyfriend will not want to use a condom (23.7%), were reported. The question addressing learners' health seeking behaviour as to where they will go for treatment if they had a sexually transmitted infection showed that 94 % will go to a clinic / doctor, 26% to a sangoma and 27% to both the clinic / doctor and the sangoma.
In terms of relationships and safe sex, 88.1 % and 93.3% ofleamers reported that Laduma taught them that faithfulness and honesty to your partner is good and that condoms should be used to practice safer sex respectively.
Ninety one percent of learners reported that they thought it was a good idea to use a photo-novella to convey a message on prevention of sexually transmitted infections.
Learners also felt that such a medium was entertaining (71 %) and the language used was similar to the way people normally speak (83%).
There were no statistically significant differences in the above responses with regard to gender or across time (when repeated at T3).
4.4 Responses of learners in the intervention group after a single reading of Laduma